Objective: To assess the effectiveness of cough in Parkinson’s Disease (PD) patients in mild, moderate and severe disease stages.

Background: Parkinson’s Disease is the second most prevalent neurodegenerative disease worldwide. Although the cardinal symptoms are motor, respiratory dysfunction is a common feature, and is a common cause of death in these patients. Previous studies have shown that PD patients exhibit multiple respiratory changes, such as, reduced ability to perform a rapid and coordinated airway muscles contraction during exertion, chest wall rigidity and cough airflow reduction. Mucus removal is dependent on the magnitude of the peak flow generated during cough. Peak cough flow (PFT) is the most reproducible way to measure cough strength, and is a valid tool for assessing and estimating glottic function and the risk of pulmonary complications in patients with neuromuscular disease. There are no standard values for peak flow measurements, but it is known that values up tp 160 l/min are correlated with extubation failure and indicative of bronchospasm.

Method: We included patients from the Movement Disorders Outpatient clinic from UNICAMP, previously diagnosed with PD according to the London brain bank criteria, age above 18 years, with the capacity to understand verbal commands, and no other neurologic disease. The cough evaluation was performed through the Peak Cough Flow and patients were asked to perform up to three attempts. The best value was recorded and used for statistical analysis.

Results: Thirteen patients were included, (mean age 64.84 + 13.99 years), eight male. We divided patients into mild (n=5), moderate (n=5) and severe (n=3) PD according to the modified H&Y scale. There was a statistically significant difference between groups as determined by one-way ANOVA (F=15.98, p=0.001). A Tukey post hoc test revealed that the peak flow from mild PD (390 + 83.06 l/min) patients was significantly different from the moderate (254 + 32.09 l/min, p=0.01) and severe (156.67 + 35.11 l/min, p= 0.01) group. There was no statistically significant difference between the moderate and severe groups (p=0.105).

Conclusion: According to Peak Flow measures, Mild PD patients are not at risk for pulmonary complications, however,  this phase might be the therapeutic target for respiratory exercises, in order to prevent future aggravations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/expiratory-strength-in-parkinsons-disease-patients-does-time-matter/